Rolling Back HIV Prosecutions

posted: 03/08/2010

While over 600 people have now been convicted worldwide of transmitting or exposing others to HIV, and some countries are making new laws for prosecuting HIV, there is some good news.

Ghana, Mauritius and other countries have rejected a ‘model law’ that proposed prosecuting HIV transmission; in the Netherlands a new policy makes prosecutions for unintentional transmission unlikely; and Sierra Leone has ended its policy of prosecuting mother to child transmission. In England and Wales, work with police, prosecutors and expert virologists have helped make successful prosecutions a rarity.
 

UNAIDS Priority
Susan Timberlake of UNAIDS stated at a International AIDS Conference session that it was now a “corporate priority” of UNAIDS to “remove punitive laws, policies, practices, stigma and discrimination that block effective responses to HIV”.
She said that it was essential that advocacy does not just consider laws, but also must dealwith law enforcement and access to justice.
 

Working with legislative bodies to remove laws is an extremely complex and time-consuming process that requires political know-how and can backfire.
 

Harm Reduction - Working with Police and Prosecutors

Timberlake suggested law enforcement approaches (engaging with the police, prosecutors and judges who make decisions on taking cases forward or not) can be more productive than risking law repeal which could backfire and make the situation worse. She said that any countries that do not yet have prosecutorial guidelines should make these high priority.

In England and Wales, because helpful law reform is unlikely, a lot of effort has been put into reducing the harm of prosecutions – and as a result of HIV prosecution and investigation guidelines few cases get to court, and convictions are now rare.
 

An English court accepted expert scientific evidence that showed the limits of phylogenetic analysis (the scientific evidence comparing the viral strains of the complainant and the accused). At first prosecutors presented phylogenetic analysis as providing definitive proof that the accused must be guilty. However expert evidence showed that two viral strains can seem closely related without there being any certainty about who had infected who. It is now a key part of police investigation guidelines and prosecution policy to use phylogenetic analysis. This evidence seriously weakens most prosecution cases and convictions are now rare.
 

Knowledge, Representation and Stigma

More still needs to be done to improve people with HIV’s knowledge of laws and their rights (‘legal literacy’) and access to legal support and services. This needs to be linked with broader efforts to reduce HIV stigma and discrimination.
 

New Book on HIV and Criminal Law

This International Conference meeting also saw the publication of HIV and the Criminal Law, a new guide to the use of the criminal law in prosecutions related to HIV transmission, written by Edwin Bernard and published free online by NAM.

Videos

The video of the meeting is now online at aidsmap
The video of Edwin's presentation and press conference

Sources
Criminalising Transmission

Tactics to Stem Tide of Prosecutions

HIV Microbicide Success

posted: 20/07/2010

A vaginal microbicide gel containing the anti-HIV drug tenofovir (Viread) reduces the risk to women of HIV infection by 39%, results of a study show. This is the most hopeful news in the years long search for something that women can use to protect themselves from HIV risk. There was a recent flurry of hope about another microbicide which showed some signs of working but further study showed it wasn't good enough.

Women who used this new gel more reliably, during four out of the last five times they had had sex saw their risk of HIV infection reduced by 54%. The microbicide also had another useful sexual health benefit, halving the risk of infection with genital herpes.
 

Other reports about this microbicide explain that women must apply the gel 12 hours before sex and once again as soon afterwards as possible.

There is more work to be done before this microbicide can supplied publicly, but this was a top-notch scientific study, a randomised, placebo-controlled trial – called CAPRISA 004 – in South Africa. 889 HIV-negative women were randomly divided into two groups, one was given the tenofovir-containing gel and the other group was also given gel that looked exactly like the first but without any tenofovir in it. No-one (neither women nor the clinic staff) knew who was getting what. Both groups of women got advice about safer sex and free condoms. The women were monitored for two and a half years.
 

Results from the study will be officially presented to the AIDS 2010 conference in Vienna today, but they have already generated a lot of excitement.
“This is an important day,” said Yasmin Halima, director of the Global Campaign for Microbicides. “We now have evidence that a vaginal gel can help prevent HIV. This is good news for women, good news for the field and a good day for science.”
 

Next Steps

To stimulate and prioritise rapid action, WHO and UNAIDS announced that they will convene an expert consultation in August with women’s health and HIV prevention advocates, scientists, microbicide research teams and product developers, and public health experts to discuss the next steps with the product.

A webcast of this session and interviews are available on the Kaiser Family Foundation website

More information from NAM/aidsmap.com

Image - Prof. Quarraisha Abdool Karim, Associate Scientific Director of CAPRISA, explains how to use an applicator with gel       from blogs.timeslive.co.za

AIDS Conference e-newsletter

posted: 12/07/2010

Sign up now for the latest news on HIV from the 18th International AIDS Conference. This major international conference opens in Vienna, Austria, on Sunday 18 July, with more than 20,000 people. This conference happens every two years and is the first place for news of the most important developments – news about progress on microbicides is expected, which is important for women. There will be much more to find out on every HIV topic under the sun.

Daily e-newsletter

NAM / aidsmap have a daily email newsletter you can sign up for now.

The conference promises interesting and varied presentations and sessions, covering a broad range of subjects in the HIV field, including new treatment, prevention and practice research.

Rights Here, Rights Now

This year's theme is ‘Rights Here, Right Now’, and the conference will have a big focus on human rights, and especially the need for science and evidence based policies for injecting drug use and HIV prevention which respect human rights.

Microbicide News

This conference will also feature keenly awaited results from the first major efficacy study of a microbicide that uses an antiretroviral drug to prevent HIV infection in women.

NAM’s team of writers will report all the conference news you need in the conference news pages of aidsmap.com every day, with links to abstracts and webcasts where these are available. During the conference NAM will send an email summary bulletin each day, presenting a round-up of news, with links to full news reports and webcasts. Sign up now for the daily conference email.
 

Laws Should Not Worsen HIV

posted: 02/07/2010

The ‘Vienna Declaration’  sounds like a half-forgotten piece of school history, but it is brand new and all about ending laws and policy across the world that cause HIV harm. The UN has at the same time set up a brand new Global Commission on HIV and the Law  to deal with some of the toughest issues in HIV. Laws and policies across the world are making the HIV epidemic worse and causing harm to many people. Anti-gay, anti-sex-worker, anti-drug, anti-HIV sex and transmission laws and policies are all the UN Commission’s new battle-ground.
 

If you agree that the law should not criminalise drug users because this makes the HIV epidemic far worse and causes more harm than good, you are invited to sign the Vienna Declaration. The Vienna Declaration is a call from the international scientific community to countries across the world (including the UK) to face the facts and recognise that the so-called 'War on Drugs' isn't working, and causes far more harm than good, particularly in the fight against HIV.

It asks the UN and countries to update drug policy and laws to end this HIV harm, discrimination against people's human rights, and to remove the legal and other barriers to effective HIV prevention, treatment and care.
You can read and sign the Vienna Declaration here  and facebook and twitter it from there
 

Why is the Declaration from Vienna? Well, the International AIDS Conference opens in Vienna in Austria later this month.

This conference is the largest HIV conference, and is held every two years, and is the one where big HIV news on treatments and almost everything else is revealed. 

New - Global Commission on HIV and the Law
The Global Commission on HIV and the Law was set up last month – the secretary general of the UN said “I urge all countries to remove punitive laws, policies and practices that hamper the AIDS response … . Successful AIDS responses do not punish people; they protect them … . We must ensure that AIDS responses are based on evidence, not ideology, and reach those most in need and most affected.”

The Commission has a challenging job – its job is to produce practical steps, based on evidence and that support human rights, that will reduce HIV transmission caused by laws and policies. So it will focus its efforts on ending laws that criminalise HIV transmission and exposure, illicit drug use, sex work, and same sex relationships. Global Commission on HIV and the Law
 

HIV and the Law is part of the Law on Trial  season at Birkbeck College this weekend, and Matthew Weait, a long-time ally of George House Trust and who works at Birkbeck as a senior law lecturer, writes about how the law should not worsen HIV discrimination and stigma, and if laws do this they do not deserve our support.

HIV Patent Pool Launched

posted: 09/06/2010

The long-awaited patent pool for HIV treatment drugs is now officially approved, and the international drug companies will now be pressed to give up their monopoly rights in July. Last night in Geneva, the final hurdle was crossed and the first-ever patent pool for HIV drugs got the official go-ahead.
 

After months of negotiations and expectations, the board of UNITAID – the international organisation set up by European donor countries to increase the supply of affordable medicines to the developing world - voted to set up the Medicines Patent Pool Foundation and give it $4.4 million in its first year.
 

The newly launched Medicines Patent Pool Foundation is expected to hit the ground running in July, persuading drug companies to hand over the patents they hold on HIV drugs so that cheap generic copies for people in poor countries can be made. The greatest benefits are expected to be in the manufacture of drugs in suitable formulations for children and in combining drugs belonging to a number of different manufacturers.
 

"What this means in practical terms," said Philippe Douste-Blazy, chair of the UNITAID Executive Board, "is that formal negotiations with the patent holders can now begin. We expect the Patent Pool Foundation to have its first licenses within a year."
 

This could be hard work. Not every major drug company is going to want to hand over its monopoly rights in a good cause, particularly when it comes to HIV drugs, for which there is a lucrative market in rich countries.
This is not the first HIV patent pool. British company GlaxoSmithKline recently set up its own, but while it has very creditably put in patents for drugs that could help against neglected diseases, it has excluded its own HIV drugs – and it holds some key HIV treatment patents. But chief executive Andrew Witty has said he will consider a UNITAID patent pool, so we wait to see what GSK will now do.

Meanwhile UNITAID is less than happy with another drug giant, Bristol Myers Squibb (see report yesterday), which is closing the only factory making a cheap generic version of ddl (didanosine) for babies. Up to 7000 babies in the developing world depend on this fall-back treatment option. The new factory is not due to open until next year.
 

Less than satisfactory answer

The Guardian’s Health Correspondent has managed to get an answer out of the drug company. This was their reply:
“Bristol-Myers Squibb takes the concerns of UNITAID about supply of [ddl] didanosine very seriously and is committed to working with all stakeholders to ensure peadiatric patients remain on treatment.
We informed UNITAID and other procurement agencies that manufacturing of [ddl] didanosine 25mg and 50mg at our plant in France will cease in June of this year. E.U. regulatory approval of the new U.S. manufacturing site is expected in February 2011.

To avoid disruption, we preventively built up inventory to twice the level of 2009 demand. We also took steps to ensure product availability immediately upon regulatory approval of the new manufacturing site. The European regulatory authorities are aware of the urgency of the situation.

A very significant and unforeseeable increase in demand of [ddl] didanosine 25mg and 50mg has however created a supply strain on Bristol-Myers Squibb products only. Supply of [ddl] didanosine 25 mg and 50 mg tablets remains available through multiple generic alternatives.
We are actively working with procurement agencies to provide [ddl] didanosine to patients in need and to ensure minimal disruption.”
 

UNITAID – the problem remains
UNITAID is not impressed "The problem persists," said a spokeswoman. The generic alternatives are not WHO-approved and therefore UNITAID will not buy them because there are not the essential permissions allowing their use. "We would like them to ensure they take all the necessary steps to ensure there isn't an interruption."
 

Source

Images
Patent Pool Hope Poster
Patent Pool Push Button